Prednisone, Hydrocortisone, and Adrenal Function – What Patients Need to Know

Why Aspergillosis Patients Are Often Given Prednisolone

Prednisolone is often prescribed for patients with aspergillosis (especially Allergic Bronchopulmonary Aspergillosis – ABPA) because it helps to reduce lung inflammation and allergic reactions triggered by Aspergillus spores. It can be life-changing in controlling breathlessness, wheeze, and repeated flare-ups. However, using steroids for weeks or months can affect the body’s own natural hormone production.

How Do I Know If I Might Need Adrenal Testing While on Prednisolone?

Prednisolone is a corticosteroid medicine. If you take it for more than a few weeks, it can “switch off” your adrenal glands, which normally make the hormone cortisol. Cortisol is essential for coping with stress, fighting infection, and maintaining energy.

You might need adrenal testing if you notice:

• Extreme tiredness or weakness, especially if it worsens when tapering your pred dose.

• Excessive sleepiness or difficulty staying awake, even when rested.

• Feeling much worse during stress or illness (for example, flu, chest infection, or surgery).

• Dizziness or fainting on standing (low blood pressure symptoms).

• Nausea, vomiting, or stomach pain that isn’t explained by infection or medicines.

• Unexplained weight loss or poor appetite.

Why Might Patients Stop Making Cortisol?

The adrenal glands may temporarily stop producing cortisol if they have been “switched off” by long-term steroid treatment. This is called secondary adrenal insufficiency. It is usually reversible, but recovery can take months or even years.

In contrast, primary adrenal insufficiency (Addison’s disease) is when the adrenal glands are damaged and stop working permanently. This is not caused by steroids, but by autoimmune or other diseases.

Symptoms of Low DHEA

The adrenal glands also produce DHEA, a weak sex hormone that contributes to mood, energy, and libido — particularly important in women. Long-term steroid use or secondary adrenal insufficiency may reduce DHEA levels.

Possible signs of low DHEA:

• Ongoing low energy or fatigue, even when cortisol is replaced

• Low mood, depression, or “flat” emotions

• Reduced libido (sex drive)

• Thinning of underarm or pubic hair (especially in women)

• Lower resilience or general sense of well-being

Not all patients with adrenal insufficiency need DHEA replacement, but in some, it can make a difference. This is assessed by specialists.

How to Tell the Difference Between Causes of Fatigue

Because fatigue can come from several overlapping sources, it helps to compare:

✅ = typical feature

Prednisolone, Hydrocortisone and Fatigue

• If a patient is on prednisolone and feels extremely fatigued during stress or illness, it may mean their body is not making enough natural cortisol.

• If they are tapering prednisolone and develop fatigue or sleepiness, this can mean the taper is too fast and the adrenal glands have not “woken up” yet.

• If a patient feels tired while still on prednisolone, it could be due to:

  • Side effects of prednisolone itself,

  • Lack of natural cortisol (adrenal suppression),

  • Or low DHEA.

Treatment and Monitoring

• Doctors may recommend slowing or pausing tapering if adrenal insufficiency is suspected.

• Some patients are switched to hydrocortisone, which more closely mimics natural cortisol.

• In situations of stress (infection, surgery, trauma), patients may need extra “stress doses” of steroids.

• Patients at risk should carry a steroid emergency card or medical alert bracelet.

👉 Key message:
Aspergillosis patients often need steroids, but long-term use can suppress natural adrenal function. Fatigue can come from:

• Low cortisol,

• Prednisolone side effects,

• Or low DHEA.

Since these overlap, specialist endocrine advice is often needed to work out the cause.